Living with food allergy: an update. Hazel Gowland: Allergy Action. November Hazel Gowland. Food allergy what are the risks?

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1 Living with food allergy: an update Hazel Gowland: Allergy Action November 2017 Peanut and nut allergy as a baby Working for and with the Anaphylaxis Campaign since 1994 Develop and delivering effective allergy training since 1995 Work with food suppliers, regulators, caterers, schools, nurseries Consumer Research for FSA on food labelling and shopping Research into food allergy deaths and near misses Hazel Gowland allergytraining.com Disclosures: Food allergy what are the risks? Conflicts of interest: None in relation to this presentation Grant/Research Support: Food Standards Agency, Laboratory of the Government Chemist, University of Bath Lecturing and presenting: University of Southampton, Imperial College, London, Association of Public Analysts, Aimmune Therapeutics Consultant/Advisory Board: Anaphylaxis Campaign, TRACE Study, ILSI Europe Death Life-threatening symptoms Anaphylaxis Mild to moderate symptoms Very minor symptoms eg tingle, itch Ownership interest: Other: None None No symptoms (Allergen exposure below minimal eliciting dose) Sensitisation immune system set up for future allergy

2 Web wisdom? September 2017: Peanut proteins in breastmilk Preventing sensitisation Immunotherapy Milk ladder Egg ladder

3 Immunotherapy Immunotherapy plus? Non-avoidance #14allergens

4 Beyond #14 allergens October 2017: Back-up AAIs in schools #carrytwo Airlines #nutban #pre-boarding #announcements #refusedboarding More research needed

5 Bullying #BSACI 2017 and #PAAM 2017 Teenagers UK: Fatal reactions to foods Data from Pumphrey & Gowland JACI 2007, Turner et al JACI 2014, inquest and media reports

6 Lessons from fatal allergic reactions Since January probable fatal reactions to foods in the UK Average age 19 (3y 55y) 14 Male: 22 Female Inquests delayed waiting for police / local authority action? Key evidence not always available Lessons from fatal allergic reactions Possible factors Possible milk with meat eg buttermilk / yogurt marinade Misunderstanding about foods to be avoided Foods prepacked for direct sale with not all allergens labelled School recognition of symptoms Poor response eg symptoms, management, #AAI practice, posture Bullying? Data from Pumphrey & Gowland JACI 2007, Turner et al JACI 2014, inquest and media reports Data from Pumphrey & Gowland JACI 2007, Turner et al JACI 2014, inquest and media reports Lessons from fatal allergic reactions Delivery companies: Where is the contract?

7 Factors influencing severity? January 2014: North Yorkshire Sensitivity Asthma history Age Metabolism Exercise / exertion Alcohol Medication + Recognised knowledge gaps Turner et al: Allergy 2015 Can we identify patients at risk from life-threatening reactions to foods? Offences R v Zaman Teesside Crown Court May 2016 Gross negligence manslaughter causing the death of Mr Wilson Placing food on the market that was unsafeand injurious to health (178/2002 EC and Food Hygiene (England) Regulations 2013) Selling food not of the substance demanded (Food Safety Act 1990) Falsely describing food as containing almonds when it contained peanuts (Food Safety Act 1990) Food offences 18 months (on their own) Sentenced to 6 years in jail in total (These offences took place before December 2014 when the Food Information Regulation 1169/2011 EC became enforceable.)

8 1. History and diagnosis 2. Contract specifying avoidance 3. Reaction timing and symptoms (CCTV) Appeal autumn Food samples Eaten / PM 5. Investigation TSO/EHO, Police, Public Analyst and FSA Support 6. Analytical methods Royal Courts of Justice Strand, London 08/11/17.. the Appellant's negligence in this case was not just gross; his behaviour, driven by money, was appalling. 7. Evidence from food suppliers & FBOs 8. Law to use Negligence? Given the very serious aggravating factors, even though the Appellant was a man of good character, we are wholly unpersuaded that a sentence of six years after a trial was manifestly excessive or, indeed, excessive at all. Conclusion The appeal in respect of both conviction and sentence is dismissed Prosecution: February 2017 Prosecution: May 2017 Woman nearly died after forkful of lamb bhuna Lal Miah handed 12,900 fine after woman's reaction to curry

9 Prosecution: June 2017 July % Confidence asking staff 56% Value staff information 44% Adventurous eating out 67% Reliable web information 63% Reliable chef dialogue 35% Improved menu information Maggie O Farrell Written information most reliable BUT some people embarrassed to have to work through big folder Knowledgeable attentive staff hugely valued BUT some people (especially coeliacs) don t want to interact Mentioning your needs when ordering (encouraged by signage) BUThard to do if noisy / at bar How busy are they? Their website was helpful Look at other people s plates Hope they have wi fi so I can check the allergens online on my phone I hope the manager will check everything Is there a QR code? I hope they ve given me the right dish..? I might just taste a tiny bit and see what happens You will want nothing more for your child, for all your children, than for them to live their lives unencumbered by worry, by discomfort, by the judgment of others. You will go to bed at night and breathe into the dark and think, one more day. I kept her alive for one more day.

10 ALLERGY ACTION Hazel Gowland BA(Hons), PGCE, MSoFHT, MREHIS, allergytraining.org